Monitoring acute traumatic brain injury requires sistemic monitoring in order to detect armful hypoxic or hypotensive events that represent the majority of secondary insults. Together with systemic monitoring it is necessary to monitor clinical (Glasgow Coma Score) and morphological (CT scan) severity of damage. There are different systems for Intracranial Pressure (ICP) monitoring afrom which the Cerebral Perfusion pressure (CPP) can be calculated. Drainage of Venous blood from the jugular bulb allows the measurement of substrate consumption by the brain (Arterovenous difference in Oxygen AVDO2). When these monitoring systems are correctly used, these parameters allow an assessment of the head trauma patient and targeting therapy according to physiopathological basis. On these monitoring there is a wide literature and a routine use that make them reliable tools in the hands of expert clinicians. Besides these monitoring, new technologies have been recently introduced in clinical practice. With these instruments it is possible to measure in a small volume of tissue CO2, O2 tension, temperature and pH i.e. to quantify bioavailability of O2 CO2 production and washout and the level of tissue acidosis together with brain temperature. With the development of semipermeable membranes introduced in the cerebral tissue, it is possible to collect dializate material from the cerebral interstitium. In this material it is then possible to measure concentrations of substrates like Glucose and Glutammate, together with Lactate and Piruvate. With these two it is possible to measure at bedside the redox state of the explored tissue. These new monitoring system are promising as the may give more accurate insight into determining cellular "well being" compared to previosly described monitoring but their real advantages must still be rigorously verified.
|Translated title of the contribution||Monitoring of brain injuries: New and old approaches|
|Number of pages||4|
|Journal||Impegno Ospedaliero, Sezione Scientifica|
|Publication status||Published - 2002|
ASJC Scopus subject areas